NHA CBCS Module 3: Coding And Coding Guidelines
QUIZ: medical necessity ANS: Process of providing diagnosis codes that support the services rendered to the patient; coding for medical necessity involves associating applicable diagnosis codes to service/procedure codes within the billing software, which is referred to as linking/linkage. QUIZ: medical record ANS: Documents health care services provided to a patient. QUIZ: query ANS: Contacting the responsible provider to request clarification about documented diagnoses or procedures. QUIZ: claim denial ANS: Unpaid medical claim returned by payer due to coding errors, missing information, preauthorization requirements, or health plan coverage issues. QUIZ: downcoding ANS: Unpaid medical claim returned by payer due to coding errors, missing information, preauthorization requirements, or health plan coverage issues. QUIZ: encounter form ANS: Financial record source document used by providers to record treated diagnoses and services provided to a patient for a single encounter. QUIZ: modifier ANS: Provides additional information about a procedure or service without altering the definition of the code description. QUIZ: preauthorization ANS: Prior approval for services granted by payer after health plan review.
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